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Dermatologists issue warning about UK artificial nail allergy epidemic

The British Association of Dermatologists has today issued a warning that (meth)acrylate chemicals, the key ingredients in acrylic nails, gel nails and gel polish nails, are causing a contact allergy epidemic in the UK and Ireland.

Their concerns are based on a study which has found that 2.4 per cent of people tested had an allergy to at least one type of (meth)acrylate chemical. This trend is a Europe-wide phenomenon, overwhelmingly affecting women.

The study looked at three main types of nail enhancements containing (meth)acrylates:

Gel nails are derived from meth(acrylates) that can be applied over the natural nail or used to sculpt extensions. The gel needs to be ‘cured’ or hardened under a UV (ultraviolet) lamp. It cannot be removed by soaking and must be buffed off from the nail.

Acrylic nails are mixed in the salon; the paste is applied over a natural nail or used to create length by adding tips. It is then left to harden with exposure to air. Acrylic nails are recommended to be removed by soaking in acetone.

Gel polish, possibly becoming the most popular of the three options, is a premixed product and a hybrid of gel and nail varnish. It has a similar consistency to nail polish and is applied in a similar way. Once applied it also requires ‘curing’ (hardening) with the use of a UV lamp. Gel polish is recommended to be removed by soaking in acetone.

Concerns have been raised about all three options, even if professionally applied. It is when the uncured products come into contact with any part of the skin that sensitisation to the chemicals can occur. This is very likely when people apply a product themselves, or if insufficient training has been given to the nail technician. Dermatologists are urging the public to be particularly wary of gel and gel polish home kits, where insufficient curing can also increase the risk of an individual developing an allergy.

Allergic reactions may involve the nails loosening, or a severe red, itchy rash, not just on the fingertips, but potentially anywhere on the body that has come into contact with the nails, including the eyelids, face, neck and genital region. Very rarely, symptoms such as breathing problems can occur.

(Meth)acrylates are also the main substance used in the production of acrylic plastics. They are used in the graphic and printing industry, aircraft manufacture, adhesives, orthopaedic cement, dressings and dentistry.

However, it is their use in the nail enhancement industry and subsequent increasingly widespread exposure which is causing alarm amongst dermatologists,

As (meth)acrylates are not routinely included in allergy assessments, known as patch tests, the rate of allergy has largely remained under the radar. There are now calls for this to change.

In an audit of 13 UK and Irish dermatology units during 2017*, a total of 4931 patients were tested for (meth)acrylate allergy. 1.5 per cent tested positive to 2-hydroxyethyl methacrylate (2-HEMA), the most common (meth)acrylate to cause allergic sensitisation, and 2.4 per cent tested positive to at least one type of (meth)acrylate. After 2-HEMA, the next two top acrylates eliciting a positive reaction were 2-hydroxypropyl methacrylate (1%) and ethyl acrylate (0.9%); the latter can also be found in medical and other adhesives.

Sixty per cent of patients in the study developed their allergy through what was termed ‘recreational exposure’, in all cases due either to the use of nail enhancements, or to nail and/or eyelash glue. In 33 per cent of cases, occupational sensitisation was the issue, and an overwhelming number of these people worked as nail beauticians. In the remaining seven per cent of cases, exposure was due to other sources such as medical adhesives and dental materials.

The audit also found that this allergy is predominantly found in women, who made up 93 per cent of those affected.

A separate survey** run by the British Association of Dermatologists, with the help of Stylfile from Apprentice Winner Tom Pellereau and Lord Sugar, of 742 people attending dermatology clinics found that 19 per cent of respondents had experienced adverse effects from acrylic nails applied in salons, and 16 per cent from gel polish nails applied in salons. Adverse effects included nail damage and allergic dermatitis such as itching and swelling of the hands, eyelids, cheeks and neck. This study also found that 26 per cent of people were applying nail enhancements at home, with 11 per cent stating they found the kit instructions inadequate.

Dr David Orton, of the British Association of Dermatologists, said:

“It is really important that people know they can develop allergies from artificial nails. The truth is that there will be many women out there with these allergies who remain undiagnosed, because they may not link their symptoms to their nails, especially if the symptoms occur elsewhere on the body. It is important that they get a diagnosis so that they can avoid the allergen, but also because developing an allergy to these chemicals can have lifelong consequences for dental treatments and surgeries where devices containing these allergens are in common use.

“The risk is particularly high for beauticians and other professionals who work with nail enhancements. Wearing protective gloves is not enough as (meth)acrylates will pass directly through many glove types. Salon owners need to consider the level of training they offer staff in this area as there is a genuine occupational hazard that should be mitigated. An important precaution is to use nitrile gloves which are replaced and disposed of every 30 minutes and removed with a ‘no touch’ technique. (Meth)acrylates should be kept away from all direct skin contact. The training also needs to reduce the chances of initiating an allergy in their clients.“

Dr Deirdre Buckley, from the Royal United Hospital Bath, President of the British Society of Cutaneous Allergy and the Consultant Dermatologist leading the 2017 audit of 13 dermatology units, said:

“Allergy to (meth)acrylates has the potential to behave like many of the other significant contact allergy epidemics that have occurred in the last few decades. Although the rate of allergy to (meth)acrylates is continuing to increase, many doctors are unaware of the issue, and these chemicals are not routinely included in patch tests. We are now recommending that all dermatologists patch test to (meth)acrylates routinely.“

“We would particularly urge people to be careful when using home kits. If you do use one, make sure that you use the recommended UV lamp for curing, and read the instructions carefully. Using the wrong lamp may mean that the gel polish does not cure properly, and this means an increased chance of allergy. Avoid any direct skin contact with the (meth)acrylate nail product.”

The researchers also noted that the issues with nail enhancements are not just limited to allergic reactions to the nails themselves, but also to nail glues, used to glue on pre-sculpted nails. The glues contain chemicals called cyanoacrylates, which are also used in ‘super glues’ and can cause severe allergic reactions.

Acrylate-containing nails can also cause physical damage to the nails and cuticles when they are removed, either by buffing, scraping or acetone soaking.

Tom Pellereau, Inventor of Stylfile, said:

“Few would believe that almost 1 in 5 respondents had experienced negative adverse effects from acrylic nails applied in salons. We hope that this study will raise awareness and encourage greater education.”

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Notes to editors:

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk

Please note that all percentages refer to the patch-tested population in the UK.

*Epidemic of (meth)acrylate allergy in U.K. requires routine patch testing
S Rolls1, A Shah2, JF Bourke3, MM Chowdhury4, P Cousen5, AM Flynn3, A Howarth6, SA Ghaffar7, C Green7, GA Johnston2, K Naido5, DI Orton8, C Reckling9, NM Stone10, D Thompson11, S Wakelin12, SM Wilkinson13, DA Buckley1.
1Royal United Hospital, Bath, UK; 2Leicester Royal Infirmary, Leicester, UK; 3South Infirmary Victoria University Hospital, Cork, Ireland; 4University Hospital of Wales, Cardiff, UK; 5South Tees Hospital NHS Foundation Trust, UK; 6Portsmouth Hospital NHS Trust; 7Ninewells Hospital, Dundee; 8Royal Free Hospital, London, UK; 9Kent and Canterbury Hospital, Canterbury, UK; 10Royal Gwent and Nevill Hall Hospitals, Newport, UK; 11Sandwell and West Birmingham Hospitals NHS Trust; 12Imperial College Healthcare NHS Trust; 13Leeds Teaching Hospital NHS Trust, Leeds, UK.

(Meth)acrylates are potent sensitizers and a common cause of allergic contact dermatitis (ACD). The frequency of (meth) acrylate ACD has increased recently with soaring demand for acrylic nails. (Meth)acrylates are not routinely tested in the baseline patch test series in the U.K. and Europe. The European Society of Contact Dermatitis (ESCD) suggests that an allergen might be included in the baseline series when the proportion of consecutively patch tested patients with a positive test to a specific allergen exceeds 0.5–1.0%. Our preliminary retrospective audit in nine U.K. dermatology centres between 2008 and 2015 found the frequency of sensitization to any (meth)acrylate to be a minimum of 1.3%; and to 2-hydroxyethyl methacrylate (2-HEMA) to be 0.7%. Patients had been selectively patch tested to (meth)acrylates based on history of exposure, therefore, the true rate of sensitization to 2-HEMA remains unknown. We performed a prospective multicentre audit, including 2-HEMA [2% in petrolatum (pet.)] in an extended baseline series in 13 U.K. dermatology units during 2017. Patients with a history of (meth)acrylate exposure, or who tested positive to 2-HEMA, were selectively tested with a series of eight (meth)acrylate allergens. A total of 4931 patients were tested, of whom 545 were also tested to the acrylate series. Of 4931 patients, 76 (1.5%) tested positive to 2-HEMA and 116 (2.4%) to at least one (meth)acrylate. Had 2-HEMA been excluded from the baseline series, 21 (0.4% of 4931) (meth)acrylate positive patients would have been missed. The top (meth)acrylates eliciting a positive reaction were 2-HEMA (n = 76; 1.5%), 2-hydroxypropyl methacrylate (n = 48; 1%) and ethyl acrylate (n = 43; 0.9%). We have shown an increase in the number of (meth)acrylate ACD cases identified when 2-HEMA is included in the baseline series, rather than relying on a history of (meth)acrylate exposure. Had 2-HEMA not been added, treatable cases of (meth)acrylate ACD would have been missed. We believe that such patients remain undiagnosed in many U.K. dermatology units. We recommend that 2-HEMA 2% pet. be added to an extended British baseline patch test series. We also suggest a standardized short (meth)acrylate series, including the most popular (meth)acrylates to test positive, which is likely to detect most cases of (meth)acrylate ACD.

**Secondary nail survey of 742 individuals conducted by the British Association of Dermatologists in dermatology clinics across the UK in 2016 and 2017.

About the British Association of Dermatologists:

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk

About StylFile:

Styfile is a range of curve nail files invented by Tom Pellereau. The company is 50:50 by Lord Alan Sugar and Tom who won the BBC Apprentice in 2011. The company aims to reinvent beauty accessories. Their most recent invention StylPro Makeup Brush Cleaner has won multiple awards and is sold around the world.
 

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Rise in skin disease due to false nails, dermatologists warn

The fashion for acrylic nails may be behind a rise in allergies being treated by dermatologists, according to research presented at the British Association of Dermatologists’ Annual Conference in Liverpool this week.

A team of researchers from Chapel Allerton Hospital in Leeds, Centre for Occupational and Environmental Health in Manchester and the Hillingdon Hospital in Uxbridge, looked at cases of occupational allergic contact dermatitis (a type of allergic eczema caused in the workplace) suffered by beauticians during a 15-year period from 1996 to 2011.

Acrylate chemicals, used in acrylic nails and eyelash extension glue, was the cause of the disease in 64 per cent of cases over the entire period, which is significantly higher than the second most common allergen, fragrances, at 24 per cent.

The study revealed a steady increase in reactions from 1996 onwards, with a four-fold increase between 1997 and 2010 (no cases in 1996, three in 1997, nine in 2009, 12 in 2010 and eight in 2011). This increase coincides with the rise in popularity of acrylic nails and eyelash extensions, as beauticians experience increased exposure to these chemicals.

This study specifically examined reactions experienced by beauticians, however the same allergies could be experienced by customers receiving these treatments on a regular basis. Acrylic nails are artificial nail enhancements that can add length to the tips and give the nails a harder finish.

The first large-scale study of the psychological impact of hand eczema, carried out by researchers at Barts and the London NHS Trust in London, is also being presented at the same conference and gives a worrying insight into the wider effects of the disease.

Of the 1023 study participants suffering from hand eczema, 89 per cent percent said that they were self-conscious and embarrassed about their hand eczema. Hand eczema also had a major impact on daily activities, with 76 per cent of respondents stating that their eczema affected their social and leisure activities, and 74 per cent their ability to work or study. Interpersonal relationships were also affected: 79 per cent of respondents stated that hand eczema had a negative impact on their mood and 27 per cent that it affected their physical relationship with their partner.

Dr Chung Kwok of Chapel Allerton Hospital, Leeds, and one of the authors of the beautician study said: “This kind of research is important in keeping doctors up to date with potential new allergens and trends in allergy caused by new products. Hand dermatitis (eczema on the hands) is common in beauty professionals because they are exposed to a great variety of chemicals.”

Author of the psychological impact study, Dr Tony Bewley of Barts and the London NHS Trust said: “The impact of hand eczema is greatly underestimated by healthcare professionals and we need to address this. It stops people working, affects their relationships and their social life – it is so much more than a minor irritation.”

Nina Goad of the British Association of Dermatologists said: “If you are either a beautician working with acrylates or a customer regularly using these products and you find you develop an eczema reaction, you will need to see your GP who will refer you to a Dermatologist for patch testing. Hand eczema is debilitating for many people, and for beauticians it can mean an inability to carry out their work, which is of course a significant problem.”

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Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.
The conference will be held at ACC Liverpool from July 9th to 11th 2013, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 (or mobile 07825567717 during conference week only) or Deborah Mason, Communications Manager, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

Study details: 
1. CD03: Occupational disease in beauticians reported to the health and occupation research network from 1996 to 2011; C. Kwok,1 A. Money,2 M. Carder,2 S. Turner,2 R. Agius,2 D. Orton3 and S.M. Wilkinson1
1Dermatology Department, Chapel Allerton Hospital, Leeds, U.K., 2Centre for Occupational and Environmental Health, Manchester, U.K. and 3Dermatology Department, The Hillingdon Hospitals, Uxbridge, U.K.

2. CD05: An ethnographic insight into the psychological impact of hand eczema
A.P. Bewley,1 N. Mason,2 J. Rawlins3 and S. Walker3
1Barts and the London NHS Trust, London, U.K., 2Stiefel, GlaxoSmithKline, Uxbridge, U.K. and 3Basilea Pharmaceuticals, Guildford, U.K.

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. 

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